scholarly journals Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

2019 ◽  
Author(s):  
Arjuna Medagama ◽  
Chamara Dalugama ◽  
Gukes Meiyalakan ◽  
Darshani Lakmali
Keyword(s):  
Platelet Count ◽  
Health Care Services ◽  
Viral Infections ◽  
Low Cost ◽  
Febrile Illness ◽  
Final Analysis ◽  
Hemorrhagic Fever ◽  
Severe Dengue ◽  
Upper Limit ◽  
Plasma Leakage

Abstract Background: Dengue is one of the most important mosquito-borne viral infections to affect humans. It is most often a self-limiting febrile illness but in some instances can progress to plasma leakage and in extreme cases culminate in death. Dengue is endemic in Sri Lanka and 2017 saw the largest outbreak on record with over 160,000 cases and over 300 deaths. Health care services reached its’ limits coping with this epidemic. The objective of this study was to identify reliable, low-cost, easily-accessible and objective predictors of Dengue hemorrhagic fever (DHF) that can be used as a triage tool in epidemic situations. Methodology/Principal findings: Serologically confirmed 350 serial adult dengue patients were included in the study. 257 (73.4%) were classified as dengue fever (DF, non leakers) and 93 (26.5%) as DHF with plasma leakage. Bedside ultrasonography was used to identify plasma leakage. Bivariate and regression analysis showed platelet count (Pearson r 0.59), and AST (r 0.27) to be significantly correlated with plasma leakage and platelet count to have a moderate predictive association (R2 0.35) with plasma leakage. Platelet count <50,000/mm3 (OR 23.7; 95% CI 12.2-45.9), AST> twice, upper limit of normal (OR 7.5; 95% CI 3.9-14.3) and ALT> twice, upper limit of normal (OR 2.4; 95%CI 1.4-3.6) increased the likelihood of DHF. In the final analysis, logistic regression identified platelet count <50,000/mm3 (OR 17.2; 95% CI 8.6-34.1) and AST>2ULN (OR 5.1, 95% CI 2.1-12.1) at time of plasma leakage as significant independent predictors of DHF. ROC curve performed for Platelet count had an AUC of .89 and at a platelet count of 50,000/mm3 predicted DHF with a sensitivity of 87% and specificity of 79%. AUC for AST was 0.72 and at 93Iu/L predicted DHF with a sensitivity of 85% and specificity of 60%. Conclusion: We have identified 2 laboratory parameters that could be used to identify plasma leakage and might be useful to stratify dengue-infected patients at risk for developing severe dengue.

scholarly journals Platelet count and AST can reliably predict the onset of plasma leakage in dengue, a low-cost triage tool during epidemics

2019 ◽  
Author(s):  
Arjuna Medagama ◽  
Chamara Dalugama ◽  
Darshani Lakmali ◽  
Gukes Meiyalakan
Keyword(s):  
Regression Analysis ◽  
Platelet Count ◽  
Dengue Fever ◽  
Dengue Hemorrhagic Fever ◽  
Low Cost ◽  
Clinical Signs ◽  
Hemorrhagic Fever ◽  
Severe Dengue ◽  
Upper Limit ◽  
Plasma Leakage

Abstract Background: Dengue is one of the most important mosquito-borne viral infections to affect humans. It is most often a self-limiting febrile illness but in some instances can progress to plasma leakage and in extreme cases culminate in death. The objective of this study was to identify reliable, low-cost, easily-accessible and objective predictors of Dengue hemorrhagic fever (DHF) that can be used as a triage tool in epidemic situations. Methods A cohort of dengue fever patients were selected and data on symptoms, clinical signs, routine lab tests, ultrasonography and packed cell volume measurements collected. The demographics and clinical characteristics of severe and non-severe dengue cases were described Bivariate and regression analysis were used to identify variables significantly correlated with plasma leak. Results Serologically confirmed 350 serial adult dengue patients were included in the study. 257 (73.4%) were classified as dengue fever (DF, non leakers) and 93 (26.5%) as DHF with plasma leakage. Bivariate and regression analysis showed platelet count (Pearson r 0.59), and AST (r 0.27) to be significantly correlated with plasma leakage and platelet count to have a moderate predictive association ( R 2 0.35) with plasma leakage. Platelet count <50,000/mm 3 (OR 23.7; 95% CI 12.2-45.9), AST> twice, upper limit of normal (OR 7.5; 95% CI 3.9-14.3) and ALT> twice, upper limit of normal (OR 2.4; 95%CI 1.4-3.6) increased the likelihood of DHF.In the final analysis, logistic regression identified platelet count <50,000/mm 3 (OR 17.2; 95% CI 8.6-34.1) and AST>2ULN (OR 5.1, 95% CI 2.1-12.1) at time of plasma leakage as significant independent predictors of DHF.ROC curve performed for Platelet count had an AUC of .89 and at a platelet count of 50,000/mm 3 predicted DHF with a sensitivity of 87% and specificity of 79%. AUC for AST was 0.72 and at 93Iu/L predicted DHF with a sensitivity of 85% and specificity of 60%. Conclusion: We have identified 2 laboratory parameters that could be used to identify plasma leakage and might be useful to stratify dengue-infected patients at risk for developing dengue hemorrhagic fever

scholarly journals Addition of Partial Envelope Domain II into Envelope Domain III of Dengue Virus Antigen Potentiates the Induction of Virus-Neutralizing Antibodies and Induces Protective Immunity

Vaccines ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 88 ◽  
Author(s):  
Jisang Park ◽  
Hyun-Young Lee ◽  
Ly Tuan Khai ◽  
Nguyen Thi Thu Thuy ◽  
Le Quynh Mai ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Dengue Fever ◽  
Neutralizing Antibodies ◽  
Subunit Vaccine ◽  
Secondary Infection ◽  
Febrile Illness ◽  
Hemorrhagic Fever ◽  
Denv Infection ◽  
Severe Dengue ◽  
Domain Iii

Dengue virus (DENV) comprises four serotypes in the family Flaviviridae and is a causative agent of dengue-related diseases, including dengue fever. Dengue fever is generally a self-limited febrile illness. However, secondary infection of patients with a suboptimal antibody (Ab) response provokes life-threatening severe dengue hemorrhagic fever or dengue shock syndrome. To develop a potent candidate subunit vaccine against DENV infection, we developed the EDII-cEDIII antigen, which contains partial envelope domain II (EDII) including the fusion loop and BC loop epitopes together with consensus envelope domain III (cEDIII) of all four serotypes of DENV. We purified Ab from mice after immunization with EDII-cEDIII or cEDIII and compared their virus neutralization and Ab-dependent enhancement of DENV infection. Anti-EDII-cEDIII Ab showed stronger neutralizing activity and lower Ab-dependent peak enhancement of DENV infection compared with anti-cEDIII Ab. Following injection of Ab-treated DENV into AG129 mice, anti-EDII-cEDIII Ab ameliorated DENV infection in tissues with primary and secondary infection more effectively than anti-cEDIII Ab. In addition, anti-EDII-cEDIII Ab protected against DENV1, 2, and 4 challenge. We conclude that EDII-cEDIII induces neutralizing and protective Abs, and thus, shows promise as a candidate subunit vaccine for DENV infection.

scholarly journals Immunophenotyping and transcriptional profiling of human plasmablasts in dengue.

2021 ◽  
Author(s):  
Charu Aggarwal ◽  
Keshav Saini ◽  
Elluri Seetharami Reddy ◽  
Mohit Singla ◽  
Kaustuv Nayak ◽  
...  
Keyword(s):  
B Cell ◽  
Chemokine Receptors ◽  
Viral Infections ◽  
Transcriptional Profiling ◽  
Dengue Infection ◽  
Febrile Illness ◽  
Hemorrhagic Fever ◽  
Hemorrhagic Fevers ◽  
Life Threatening ◽  
Systemic Infections

Plasmablasts represent a specialized class of antibody secreting effector B cell population that transiently appear in blood circulation following infection or vaccination. The expansion of these cells generally tends to be massive in patients with systemic infections leading to viral hemorrhagic fevers such as dengue or ebola. To gain a detailed understanding of the human plasmablast responses beyond antibody expression, here we performed immunophenotyping and RNA seq analysis of the plasmablasts from dengue febrile children in India. We found that the plasmablasts expressed several adhesion molecules and chemokines or chemokine receptors that are involved in endothelial interactions or homing to inflamed tissues including skin, mucosa, and intestine; and upregulated expression of several cytokine genes that are involved in leukocyte extravasation and angiogenesis. These plasmablasts also upregulated expression of receptors for several B cell pro-survival cytokines that are known to be induced robustly in systemic viral infections such as dengue, some of which generally tend to be relatively higher in patients manifesting hemorrhage and/or shock compared to patients with mild febrile infection. These findings improve our understanding of human plasmablast responses during the acute febrile phase of systemic dengue infection. Importance Dengue is globally spreading, with over 100 million clinical cases annually, with symptoms ranging from mild self-limiting febrile illness to more severe and sometimes life-threatening dengue hemorrhagic fever or shock, especially among children. The pathophysiology of dengue is complex and remains poorly understood despite many advances indicating a key role for antibody dependent enhancement of infection. While serum antibodies have been extensively studied, the characteristics of the early cellular factories responsible for antibody production, i.e., plasmablasts, are only beginning to emerge. This study provides a comprehensive understanding of the transcriptional profiles of human plasmablasts from dengue patients.

scholarly journals Spontaneous Splenic Rupture in Severe Dengue

2013 ◽  
Vol 1 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Ahmad Mursel Anam ◽  
Mohammad Mufizul Islam Polash ◽  
Md Motiul Islam ◽  
Muhammad Mahbubur Rahman Bhuiyan ◽  
ARM Nooruzzaman ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Splenic Rupture ◽  
Febrile Illness ◽  
Acalculous Cholecystitis ◽  
Severe Dengue ◽  
Spontaneous Splenic Rupture ◽  
History Of ◽  
Plasma Leakage ◽  
Laboratory Investigations ◽  
High Index Of Suspicion

Dengue is a mosquito-borne systemic viral infection with variety of clinical presentation, ranging from mild febrile illness to severe and fatal disease. A patient presented with history of fever and abdominal pain, and later developed shock. From clinical and epidemiological features, he was diagnosed as a patient of severe dengue, later confirmed by laboratory investigations. In dengue, shock can result from plasma leakage, and abdominal pain may be a feature of acalculous cholecystitis or pancreatitis, recognised presentations of dengue and usually managed conservatively. But high index of suspicion persuaded abdominal imaging, revealing a potentially fatal complication of dengue- spontaneous splenic rupture. Aggressive resuscitation and early surgery saved the patient. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14373 Bangladesh Crit Care J March 2013; 1: 59-62

scholarly journals Pathogenesis of Dengue virus in Host immune system and its genomic variation

2021 ◽  
Vol 6 (1) ◽  
pp. 16-30
Author(s):  
Sohail Sohail ◽  
Mukarram Farooq ◽  
Fareeha Sohail ◽  
Hamza Rana ◽  
Husnain Karim ◽  
...  
Keyword(s):  
T Cells ◽  
Dengue Virus ◽  
Febrile Illness ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Genomic Variation ◽  
Severe Dengue ◽  
Host Immune System ◽  
Ns1 Protein ◽  
Protein Cleavage

Dengue viruses are the most prevalent arthropod-borne viral diseases in humans, infecting 50-100 million people each year. Its serotypes are the most common causes of arboviral illness, putting half of the world's population at risk of infection. Because there is no vaccine or antiviral medicines, the only way to manage the disease is to reduce the Aedes mosquito vectors. DENV infection can be asymptomatic or cause a self-limiting, acute febrile illness with varying degrees of severity. High fever, headache, stomach discomfort, rash, myalgia, and arthralgia are the typical symptoms of dengue fever (DF). Thrombocytopenia, vascular leakage, and hypotension are symptoms of severe dengue, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Systemic shock characterizes DSS, which can be deadly. Dengue virus infection pathogenesis is linked to a complex interaction between virus, host genes, and host immune response. Major drivers of disease vulnerability include host factors such as antibody-dependent enhancement (ADE), memory cross-reactive T cells, anti-DENV NS1 antibodies, autoimmunity, and genetic variables. The NS1 protein and anti-DENV NS1 antibodies were thought to be involved in the development of severe dengue. The progressive infection may change the cytokine response of cross reactive CD4+ T cells. The need for dengue vaccines that can generate strong protective immunity against all four serotypes is required. To create such vaccines, a thorough understanding of DENV adaptive immunity is required. Structural and functional research have shown that the degree of prM protein cleavage as well as the ensemble of conformational states sampled by virions influence DENV sensitivity to antibody-mediated neutralization, which has crucial implications for vaccine formulation.

scholarly journals A Clinical Study of the Association of Thrombocytopenia with Acute Febrile Illness

2022 ◽  
Vol 9 (3) ◽  
pp. 12-15
Author(s):  
Gangum Venkatreddy ◽  
Shireesha Gugloth
Keyword(s):  
Platelet Count ◽  
Enteric Fever ◽  
Viral Infections ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Platelet Counts ◽  
Chest X Ray ◽  
The Common ◽  
Time Of Admission

Abstract Background: Thrombocytopenia accompanying acute febrile illnesses is a matter of concern because lack of prompt treatment could result in significant mortality. We in this study tried to evaluate the clinical profile of cases with acute fever and thrombocytopenia and determine the cause of fever with thrombocytopenia and the outcome of treatment of such patients in our hospital. Methods: A total of n=50 successive cases of acute febrile illness with thrombocytopenia following inclusion and exclusion criteria were included in this study. Clinical signs such as rashes, signs of dehydration, petechiae, jaundice, lymphadenopathy, hepatomegaly, splenomegaly, anemia, abdominal tenderness, altered sensorium, were noted. Investigations included CBP, ESR, LFT, RFT, serum electrolytes, Chest X-ray, USG abdomen were done. Other investigations included Dengue serology, Malaria, Widal, IgM for leptospirosis, sputum for AFB. Results: Out of n=50 patients with acute fever with thrombocytopenia, all of them had a definitive diagnosis with malaria (40%) as the commonest cause, followed by enteric fever (24%), viral fever (14%), septicemia (6%), dengue (14%), and leptospirosis (2%). 50% of the patients had platelet count in the range of 50, 000 – 1,00, 000 and 30% had platelet counts above 100000-150000. 8% of cases had platelet counts below 25000 and 12% had platelet counts between 25000-50000 at the time of admission. 10% mortality was observed. Conclusion: infections as the commonest cause of thrombocytopenia. Malaria, dengue enteric fever, leptospirosis, and other viral infections formed the major diseases in this group of population. The diagnosis of malaria was the common cause because of seasonal and regional variations. A definitive increase in platelet count was noted after the underlying cause was treated. Severe cases of septicemia with associated co-morbidities resulted in mortality.

ASSESSMENT OF THE PLATELET COUNT IN THE PREGNANT WOMEN IN IGIMS, PATNA, BIHAR

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Tanwi Singh ◽  
Anshuman Sinha
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Screening Test ◽  
Low Cost ◽  
Medical Science ◽  
Cost Effective ◽  
Platelet Indices ◽  
Increased Risk ◽  
Low Platelet Count ◽  
Severity Of The Disease

The major risk associated with low platelet count in pregnancy is the increased risk of bleeding during the childbirth or post that. There is an increased blood supply to the uterus during pregnancy and the surgical procedure requires cutting of major blood vessels. Women with thrombocytopenia are at increased risk of losing excessive blood. The risk is more in case of caesarean delivery as compared to vaginal delivery. Hence based on above findings the present study was planned for Assessment of the Platelet Count in the Pregnant Women in IGIMS, Patna, Bihar. The present study was planned in Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India. The present study was planned from duration of January 2019 to June 2019. In the present study 200 pregnant females samples received for the platelet estimation were enrolled in the present study. Clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease. Platelet count is a simple, low cost, and rapid routine screening test. Hence the data generated from the present study concludes that platelet count can be used as a simple and cost effective tool to monitor the progression of preeclampsia, thereby preventing complications to develop during the gestational period. Keywords: Platelet Count, Pregnant Women, IGIMS, Patna, Bihar, etc.

scholarly journals Hyperventilation in Children with Dengue Hemorrhagic Fever (DHF)

2019 ◽  
Vol 31 (9-10) ◽  
pp. 245-56
Author(s):  
Kasim Y. A. ◽  
Anky Tri Rini K. E. ◽  
Sumarmo S. P. S.
Keyword(s):  
Dengue Hemorrhagic Fever ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Lung Edema ◽  
Respiratory Problems ◽  
Ventilatory Pattern ◽  
Grade Ii ◽  
Plasma Leakage ◽  
The Difference ◽  
Respiratory Disturbance

Many studies of Dengue Hemorrhagic Fever (DHF) have been done but only a few revealed the respiratory status. Respiratory problems arise. because of plasma leakage through the 'damaged capillaries, causing lung edema and in turn result in hypoxemia. This later on will be compensated by a hyperventilation state. During a 6-month-period (May to September 1988), two aspects were studied in 85 patients hospitalized with DHF. First, the ventilatory pattern and second, the result of giving oxygen support in improving the respiratory disturbance, in this case alveolar hyperventilation. The incidence of alveolar hyperventilation in DHF grade II (DHF II) and Dengue Shock Syndrome (DSS) differed significantly. Hypoxemia occurred in DHF II and DSS with no significant differences. The difference of the incidence of metabolic acidosis in DHF II and DSS were significant. In DHF II patients having had hyperventilation state, oxygen therapy decreased respiration rate significantly and increased the PaC02 though not significantly.

scholarly journals Methods of Respiratory Virus Detection: Advances towards Point-of-Care for Early Intervention

Micromachines ◽  
2021 ◽  
Vol 12 (6) ◽  
pp. 697
Author(s):  
Siming Lu ◽  
Sha Lin ◽  
Hongrui Zhang ◽  
Liguo Liang ◽  
Shien Shen
Keyword(s):  
Viral Load ◽  
Respiratory Virus ◽  
Viral Infections ◽  
Point Of Care ◽  
Human Life ◽  
Low Cost ◽  
Virus Detection ◽  
Frequent Monitoring ◽  
User Friendly ◽  
New Strategies

Respiratory viral infections threaten human life and inflict an enormous healthcare burden worldwide. Frequent monitoring of viral antibodies and viral load can effectively help to control the spread of the virus and make timely interventions. However, current methods for detecting viral load require dedicated personnel and are time-consuming. Additionally, COVID-19 detection is generally relied on an automated PCR analyzer, which is highly instrument-dependent and expensive. As such, emerging technologies in the development of respiratory viral load assays for point-of-care (POC) testing are urgently needed for viral screening. Recent advances in loop-mediated isothermal amplification (LAMP), biosensors, nanotechnology-based paper strips and microfluidics offer new strategies to develop a rapid, low-cost, and user-friendly respiratory viral monitoring platform. In this review, we summarized the traditional methods in respiratory virus detection and present the state-of-art technologies in the monitoring of respiratory virus at POC.

scholarly journals Potential Agents against Plasma Leakage

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Jeanne Adiwinata Pawitan
Keyword(s):  
Protein Kinase ◽  
Focal Adhesion ◽  
Rho Gtpases ◽  
Deleterious Effect ◽  
Bacterial Infections ◽  
Severe Dengue ◽  
Caveolin 1 ◽  
Plasma Leakage ◽  
Angiopoetin 1 ◽  
Kinase A

Shock due to severe plasma leakage may happen in infectious diseases such as severe dengue and sepsis due to various bacterial infections, which may be deleterious and may lead to death. Various substances and proteins are known to modulate the effects of proleakage mediators and counteract the deleterious effect of plasma leakage. Some of the various substances and proteins such as focal adhesion kinase (FAK), the Rho GTPases, protein kinase A, and caveolin-1 have dual actions; therefore they are not suitable for therapy. However, sphingosine 1phosphate and its receptor agonists, Angiopoetin-1, Slit, and Bbeta15–42 may be promising.

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